26 May Directly Observed Therapy Linked To Lower Mortality In Multi-Drug Resistant TB
MedicalResearch.com Interview with:
Dr. Jorge Salinas MD
Epidemic intelligence service officer
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
MedicalResearch.com: What is the background for this study?
Response: Because multidrug-resistant TB (MDR TB) treatment regimens are less effective, more complex, and are more likely to have side effects that are difficult to tolerate than regimens for drug-susceptible TB, patients with MDR TB are at a higher risk of dying. Directly observed therapy (a therapy by which patients meet with a healthcare worker at a regularly scheduled time and place so the healthcare worker can observe the patient taking their TB medication) is recommended to treat all forms of TB disease, including MDR TB.
MedicalResearch.com: What are the main findings?
Response: Our analysis found that in the United States, all-cause mortality during treatment has declined among patients with MDR TB. Specifically, all-cause mortality for MDR TB decreased from 31 percent during 1993-2002 to11 percent during 2003-2013. After accounting for improvements in TB treatment, declines in HIV/TB comorbidity, and the introduction of better HIV treatment between these two time periods – the only consistent risk factors for death were older age and reported HIV infection. The only protective factor was receiving directly observed therapy (DOT). It should be noted that during these same time periods, DOT for MDR TB cases increased from 74 percent to 95 percent.
MedicalResearch.com: What should readers take away from your report?
Response: Directly observed therapy is already recommended to treat all forms of TB disease, but it’s valuable to have these data because they expand our knowledge of how to best treat MDR TB. DOT coverage has increased and remained protective over time against all-cause MDR TB mortality. This protective effect may come from directly observed therapy alone or from other patient-centered measures given along with DOT to improve treatment adherence. Examples of such measures include transportation assistance or food stamps.
The findings of this analysis reinforce that all patients with MDR TB should receive DOT and other patient-centered measures to ensure patients complete their treatment.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need to continue exploring strategies to improve treatment outcomes for people living with MDR TB. Innovative strategies, such as video DOT or e-DOT, could allow the delivery of DOT to more people, but research is needed to determine their effectiveness in improving health outcomes.
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Citation: Presented at the 2017 ATS Meeting
Factors Associated with Mortality Among Patients with Multidrug-Resistant Tuberculosis–United States, 1993-2013
J.L. Salinas, L.R. Armstrong, J.P. Cegielski, M.B. Haddad, B.J. Silk; Centers for Disease Control and Prevention – Atlanta, GA/US
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